State Medicaid Guide

What is Medicaid?

Medicaid is a joint federal and state program that provides health coverage to low-income children, pregnant women, parents, adults, and individuals with disabilities. All states, the District of Columbia, and the US territories have Medicaid programs. The federal government has established guidelines for all states to follow, however each state administers their program differently, causing Medicaid coverage to vary across the country.

How do I sign up?

In 2014, the Affordable Care Act allowed states to expand Medicaid coverage to adults age 19-64. Some states have chosen not to expand coverage to low income adults, but may choose to do so at any time.

Enrollment for Medicaid is open year-round. There are two ways to apply for Medicaid:

Through the Federal Health Insurance Marketplace (healthcare.gov);

Or through a state Medicaid agency

State agency information can be found on each individual state Medicaid page.

How much will it cost?

Applying for Medicaid is always free. There are no monthly premiums required to obtain health coverage through Medicaid. However, some who receive Medicaid will pay co-payments for certain services, such as non-emergency use of ER visits and prescription drugs. States determine what services require co-payments from Medicaid patients and rates are different in every state. Pregnant women, children under 18, and Native Americans are exempt from the co-pay requirement. Some services are exempt from co-payments, including family planning, preventive services, and emergency medical services.

What documents are needed to apply?

Social Security number (or document number for permanent residents)

Employer and income information for everyone in the household (pay stubs, W-2, or income tax statement)

The number of people that are claimed as a dependent on the applicant’s tax return or if the applicant will be claimed by someone else on their tax return

Policy numbers for any current health insurance coverage for the applicant

Information about any job-related health insurance available to the applicant and/or their family

When do benefits start?

Once the agency determines an individual is eligible for Medicaid, coverage begins either on the date of application or the first day of the month of application. Benefits can also cover medical expenses three months prior to application, if a person would have been eligible for that period had they applied. Coverage stops at the end of the month in which a person no longer meets the requirements for eligibility (usually because income is too high).

What medical services are covered?

States determine some of what medical services are covered with Medicaid. However, there are mandatory benefits that are required by the federal government that are the same in all states. Mandatory benefits include inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and transportation to medical care. States have the choice of covering optional benefits like dental services. Medicaid is accepted at all Federally Qualified Health Centers which provide primary care services. Entering a zip code at https://findahealthcenter.hrsa.gov/index.html results in a list of area health centers to receive medical services.

The Transamerica Center for Health Studies® (TCHS) – a division of the Transamerica Institute® – is focused on empowering consumers and employers to achieve the best value and protection from their health coverage, as well as the best outcomes in their personal health and wellness. The Transamerica Institute® is a nonprofit, private foundation funded by contributions from Transamerica Life Insurance Company and its affiliates, as well as unaffiliated third parties. None of the contributors are major medical insurers. TCHS and TI and their representatives cannot give ERISA, tax, or legal advice, and TCHS is not an agent of any government agency including, but not limited to, state or federal health benefit exchanges. This material is provided for informational purposes only and should not be construed as ERISA, tax, or legal advice. TCHS and its representatives are not registered brokers, navigators, applicant assistors, or promoters. Although care has been taken in preparing this material and presenting it accurately, TCHS disclaims any express or implied warranty as to the accuracy of any material contained herein and any liability with respect to it.
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